Sepsis is a dangerous and common medical emergency. According to The Journal of the American Medical Association, a large United States inpatient sample revealed both that sepsis currently accounts for a remarkable 1 in every 2-3 hospital deaths and that the typical fatality was admitted to the hospital with less severe symptoms before worsening and succumbing to illness. Once severe sepsis has developed, it has a very high mortality rate. Three recent multicenter trials, published in the New England Journal of Medicine, demonstrated that none of the leading strategies for treating septic shock was superior, and none improved mortality to less than 20%. Yet despite this staggeringly high mortality, current medical practice lacks standards about some of the most basic aspects of sepsis care, which puts patients at risk and creates medico-legal risk for the care provider and the hospital. The problem arises because sepsis has an insidious onset. It begins with a more mild form of infection, before it develops into a truly life-threatening illness. In theory, if aggressive treatment were to be initiated and consequently administered when the infection was in its earlier, milder state, then sepsis and critical illness could be either avoided altogether, or at least mitigated. Yet mild infections are exceedingly common, and there is currently no single test or clinical finding that clearly defines the progression of infection and the development of a severe, life-threatening septic state.
The strategies currently employed to combat sepsis leave much to be desired, as sepsis has a high mortality rate and causes a large portion of hospital deaths. In the past, much attention has focused on early sepsis detection. One approach attempts to automatically diagnose sepsis based on vital signs and alert the clinician. However, such an approach does not account for the insidious onset of sepsis and the consequence that the patient's condition evolves over time, while management may lag. Some systems attempt to enforce general clinical orders to avoid lapses, ranging from delayed enactment of initial orders to delayed re-evaluation and delayed ordering of subsequent treatments, but these systems do not yield improved outcomes if the treatment provided is idiosyncratic and not reconsidered frequently.